Nondrug Therapies Case Study
What nondrug therapies should clinicians recommend?
Lifestyle and dietary modifications are effective for specific types of CKD. Clinicians should advise all patients with CKD to quit smoking; exercise for 30 minutes most days of the week; limit alcohol intake (1 drink/day for women, 2 drinks/day for men); maintain body mass index within the normal range (18.5–
24.9 kg/m2); and eat a diet high in fruit, vegetables, and whole grains (34–35). The DASH diet is recommended for patients with a
GFR >60 mL/min/1.73 m2 and high-normal blood pressure or stage 1 hypertension but not those with lower GFR (CKD stages 3 or 4) because it contains a higher-than-recommended amount of protein, potassium, and phosphorous (34). Although salt restriction in the …show more content…
In a study of primary angioplasty, 119 patients were assigned to a double dose of N-acetylcysteine,
116 patients to standard-dose Nacetylcysteine, and 119 patients to placebo. All patients received intravenous fluids for 12 hours after the procedure at a rate of 1 mL/ kg/h. Contrast medium–induced nephropathy, defined as an increase in the serum creatinine of 25% or more, was observed in 8% of patients in the double-dose group, 15% of pa-
Diagnosis... CKD is defined as kidney damage or a GFR <60 mL/min/
1.73 m2 for a period longer than 3 months. CKD should be classified based on levels of GFR and albuminuria. The first step in diagnosis is to determine whether a patient has diabetic nephropathy; hypertensive nephropathy; or nondiabetic, nonhypertensive kidney disease. The history and physical examination often point to a cause, but a definitive diagnosis requires various diagnostic tests, renal ultrasonography, and sometimes renal biopsy.
CLINICAL BOTTOM LINE
34. Kidney Disease Outcomes
Quality Initiative
(K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.
Am J Kidney Dis.
Lifestyle and dietary modifications are effective for specific types of CKD. Clinicians should advise all patients with CKD to quit smoking; exercise for 30 minutes most days of the week; limit alcohol intake (1 drink/day for women, 2 drinks/day for men); maintain body mass index within the normal range (18.5–
24.9 kg/m2); and eat a diet high in fruit, vegetables, and whole grains (34–35). The DASH diet is recommended for patients with a
GFR >60 mL/min/1.73 m2 and high-normal blood pressure or stage 1 hypertension but not those with lower GFR (CKD stages 3 or 4) because it contains a higher-than-recommended amount of protein, potassium, and phosphorous (34). Although salt restriction in the …show more content…
In a study of primary angioplasty, 119 patients were assigned to a double dose of N-acetylcysteine,
116 patients to standard-dose Nacetylcysteine, and 119 patients to placebo. All patients received intravenous fluids for 12 hours after the procedure at a rate of 1 mL/ kg/h. Contrast medium–induced nephropathy, defined as an increase in the serum creatinine of 25% or more, was observed in 8% of patients in the double-dose group, 15% of pa-
Diagnosis... CKD is defined as kidney damage or a GFR <60 mL/min/
1.73 m2 for a period longer than 3 months. CKD should be classified based on levels of GFR and albuminuria. The first step in diagnosis is to determine whether a patient has diabetic nephropathy; hypertensive nephropathy; or nondiabetic, nonhypertensive kidney disease. The history and physical examination often point to a cause, but a definitive diagnosis requires various diagnostic tests, renal ultrasonography, and sometimes renal biopsy.
CLINICAL BOTTOM LINE
34. Kidney Disease Outcomes
Quality Initiative
(K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.
Am J Kidney Dis.